Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.
ABSTRACTinjury classification and severity score (TLICS), described by Vaccaro et al. (7). In this system, most type A fractures of the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification system, even burst-type fractures in the thoracolumbar junction that had usually been operated on before, are classified within the conservative treatment group █ INTRODUCTION T raumatic spinal fractures are quite common lesions. In recent years, there has been a trend towards conservative treatment instead of surgery for thoracic, thoracolumbar, and lumbar fractures. This is partly due to the widening usage of a new classification system, thoracolumbar AIM: Conservative treatment is a frequently used treatment modality for traumatic thoracolumbar fractures. However, not many studies evaluating radiological and clinical results of conservative treatment are found. The aim of this study was to determine the risk factors, and compression and kyphosis rates after 1 year in patients with AO type A thoracic, thoracolumbar, and lumbar fractures treated conservatively. MATERIAL and METHODS:Radiological and clinical results of 79 thoracolumbar fractures in 57 patients, who were treated conservatively, were evaluated one year after trauma. Fractures were classified according to thoracolumbar injury classification and severity (TLICS) score and AO spinal trauma classification system. Compression rate, wedge and kyphosis angles, and sagittal index were calculated in early and late periods after trauma. RESULTS:Female/male ratio was 25/32, and mean age was 41.7±16.7 years. They were followed for 15.2±4.9 months. Mean compression rates were 19.6% and 25.2%; wedge angles were 10.1 and 12.7 degrees; kyphosis angles were 5.82 and 8.9 degrees; and sagittal indexes were 8.01 and 10.13 in all patients just after trauma and after one year, respectively. Fractures in older patients (>60 years of age) and in patients with osteopenia or osteoporosis, located in the thoracolumbar junction, AO type A2 and A3 fractures, and solitary fractures had higher compression and kyphosis rates at last follow-up. CONCLUSION:Early mobilization without bed rest for stable thoracolumbar fractures according to the TLICS system is a good treatment option, and radiological and clinical results are usually acceptable. However, fractures in patients older than 60 years, those with osteoporosis or osteopenia, fractures located in the thoracolumbar junction, solitary fractures, and fractures in AO type A2 or A3, are more inclined to increase in compression and kyphosis and may require a closer follow-up.
Context: Spinal osteoid osteoma (OO) is an infrequent tumor and due to both its smallness and complex anatomy of the spine diagnosis is challenging. In addition, associated undefined soft tissue changes on magnetic resonance imaging (MRI) frequently cause misdiagnosis. Evidence Acquisition: PubMed database was searched for "spinal osteoid osteoma" and larger clinical series related to clinical pictures, diagnosis or treatment modalities, and also case reports with especially soft tissue changes and related to special treatment modalities were introduced to the study. It was aimed at to make conscious practitioners of clinical and diagnostic characteristics of spinal OOs. Results: Spinal OOs constitute about 10% of OOs and the most of the tumors are seen in adolescents or young adults. The most frequent clinical picture is painful scoliosis or torticollis according to the level of the tumor. On MRI that is the most frequently performed imaging modality in the patients with painful scoliosis, undefined extensive bone and soft tissue changes is quite frequent. Clinicians must be aware from these findings and they must suspect and investigate the patients with bone scintigraphy and thin sectioned computerized tomography that both of them together can show presence of the lesion and provide to determine exact location of the lesion. Despite the increasing number of the studies using percutaneous ablation techniques, standard treatment of spinal OOs is still intralesional excision. Surgical excision usually provides immediate pain relief, and recurrence is not frequent. Conclusions: Diffuse paravertebral muscle and soft tissue involvement having resemblance to myositis is not quite rare in the patients with spinal OO. This may be the sole finding on MRI and it must be alert for the clinicians to look for small OO nidus by bone scintigraphy or thin sectioned CT scan.
Laminar screw technique is easy, safe and effective at C2, C7 and upper thoracic levels. Some modifications may be required due to the anatomical variations.It can be used at other subaxial levels also in theselected cases that other techniques could not be performed.
Objective: To evaluate and compare the radiological changes on adjacent mobile segments and clinical findings in patients having undergone single-segment simple anterior cervical discectomy versus discectomy plus intervertebral fusion. Material and Methods: Twenty-five patients were treated with discectomy plus fusion and 20 patients with simple discectomy. Clinical pictures of the patients were evaluated with ODOM criteria before and 1 year after operation, and their improvement rates were calculated. The disc heights of superior and inferior adjacent segments, superior and inferior foramen heights, superior and inferior end plate heights of superior and inferior adjacent segments, new osteophyte development, segmental angulation and loss of cervical lordosis were evaluated on cervical radiographies before and 1 year after operation. Results: Although there were new degenerative findings in adjacent mobile segments in all patients when preoperative and postoperative measurements were compared, these radiological findings did not translate into clinical findings. In the fusion group, radiological degeneration findings were seen more frequently statistically; however, clinical results were not different between the two groups. On the other hand, loss of lordosis was significantly more frequent in the simple discectomy group. Conclusion: Although adding fusion to single-segment anterior cervical discectomy caused more frequent radiological degenerative changes in adjacent segments after 1 year compared to simple discectomy, clinical results were similar. It was thought that longer follow-up was necessary to observe clinical adjacent segment disease that was expected to become more frequent because of excessive mobility due to fusion. Keywords: Discectomy, intervertebral disc displacement, spinal fusions -adverse effects ÖZETTek seviye anterior servikal diskektomi ile diskektomi ve füzyon sonrası radyolojik ve klinik komşu seviye dejenerasyonu oranlarının karşılaştırılması Amaç: Tek seviye basit anterior servikal diskektomi uygulanan olgularda komşu seviyelerde gelişen radyolojik değişiklikleri ve klinik bulguları diskektomiyle birlikte füzyon uygulanan olgularda görülenlerle karşılaştırmak. Gereç ve Yöntemler: Diskektomiyle birlikte füzyon uygulanan 25, basit diskektomi uygulanan 20 olgu vardı. Olguların klinik tabloları girişim öncesinde ve girişimden 1 yıl sonra ODOM kriterlerine göre değerlen-dirildi ve iyileşme oranları hesaplandı. Üst ve alt komşu seviyelerdeki disk yükseklikleri, üst ve alt foramen yükseklikleri, üst ve alt komşu seviyelerin üst ve alt son plaklarının yükseklikleri, yeni osteofit gelişimi, segmenter açılanma ve servikal lordoz derecesi girişim öncesi ve girişimden 1 yıl sonraki grafilerde ölçüldü. Bulgular: Girişim öncesi ve 1 yıl sonraki ölçümler karşılaştırıldığında bütün olgularda bütün komşu seviyelerde yeni dejeneratif değişiklikler ortaya çıkmasına rağmen radyolojik bulgular klinik bulgulara yansıma-mıştı. Füzyon grubunda radyolojik dejenerasyon bulguları anlamlı olarak daha sı...
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